title: [Severe punding in Parkinson's disease].
abstract: BACKGROUND
  Punding is a stereotypical behavior characterized by an intense fascination with repetitive handling and examining of mechanical devices or arranging common objects. This condition, which is different from both obsessive-compulsive disorder and mania, is still underestimated in patients with Parkinson's disease and may have deleterious social consequences on patients and their families.
  
  
  METHODS
  We report the case of severe punding in a 23-year-old parkinsonian woman, who presented, a few days following a rise in the dose of pergolide up to 2,5 mg/(d), frequent and daily unusual repetitive behavior, characterized by ceaseless sewing, disassembly and reassembly of phones, and coloring of drawings. These behaviors were associated with a common peak of dose dyskinesia and were responsible for a considerable reduction in duration of sleep with negative impact on the quality of life of her parents. These symptoms significantly improved immediately after switching pergolide to an equivalent dose of ropinirole (12 mg/(d).
  
  
  CONCLUSIONS
  Punding has only recently come to the attention of physicians through the first report in a parkinsonian patient, triggered by dopaminergic replacement therapy. The phenomenon was thought to be related to excessive dopaminergic stimulation of the limbic and associative pathways. The current mainstay of treatment is the reduction in the dose of dopaminergic medication or changing the presumed responsible drug, often a dopaminergic agonist. In this article, the authors review the epidemiology, pathophysiology and management of this curious phenomenon.
authors.affiliation: Service de neurologie, CHU Ibn Rochd, Casablanca, Maroc. Electronic address: hichamotmani@hotmail.com.
authors.forename: H
authors.initials: H
authors.lastname: El Otmani
authors.affiliation: Service de neurologie, CHU Ibn Rochd, Casablanca, Maroc.
authors.forename: L
authors.initials: L
authors.lastname: Raji
authors.affiliation: Service de neurologie, CHU Ibn Rochd, Casablanca, Maroc.
authors.forename: B
authors.initials: B
authors.lastname: El Moutaouakil
authors.affiliation: Service de neurologie, CHU Ibn Rochd, Casablanca, Maroc.
authors.forename: M A
authors.initials: MA
authors.lastname: Rafai
authors.affiliation: Service de neurologie, CHU Ibn Rochd, Casablanca, Maroc.
authors.forename: I
authors.initials: I
authors.lastname: Slassi
mesh_terms: D003241:Consanguinity; D003937:Diagnosis, Differential; D004305:Dose-Response Relationship, Drug; D057915:Drug Substitution; D005260:Female; D006801:Humans; D007211:Indoles / Q000627:therapeutic use; D010300:Parkinson Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000235:genetics / Q000523:psychology*; D010479:Pergolide / Q000009:adverse effects* / Q000627:therapeutic use; D013239:Stereotyped Behavior / Q000187:drug effects*; D055815:Young Adult
chemical_list: D007211:Indoles; C046649:ropinirole; D010479:Pergolide
keywords: Dopamine dysregulation syndrome; Maladie de Parkinson; OCD; Parkinson's disease; Punding; Syndrome de dysrégulation dopaminergique; TOC